title: Decision making and results of coronary artery bypass grafting for patients with poor left ventricular function.
abstract: BACKGROUND
  The aim of this study is to determine the results of coronary artery bypass surgery in patients with a low ejection fraction. Between January 2007 and January 2011, 3556 consecutive patients who underwent coronary artery bypass grafting at the Cardiovascular Surgery Clinic at Sifa University Hospital, Izmir, Turkey, were analyzed retrospectively.
  
  
  METHODS
  The patients were divided into 2 groups. Patients undergoing isolated first-time elective coronary bypass surgery were classified according to their preoperative ejection fraction; Patients in Group I had an ejection fraction between 20% and 35% with poor left ventricular function (n = 1246; 695 men and 551 women; mean age, 62.25 ± 5.72 years, range, 47-78 years). Control patients in Group II underwent elective coronary artery bypass grafting at the same time and had left ventricular ejection fraction between 36% and 49% (n = 2310; 1211 men and 1099 women; mean age, 61.83 ± 8.12 years, range, 41-81 years). The mean follow-up time for all patients was 24 ± 9.4 months (range, 12-48 months). Patients were followed postoperatively at the end of the first month and every 6 months. The left ventricular ejection fraction was assessed by transthoracic echocardiography.
  
  
  RESULTS
  The mean number of distal anastomoses, myocardial infarction, and mean age was not significantly different between the 2 groups; however, cross-clamp time was longer in Group I. Patient recovery time was significantly longer in Group I. Morbidity (14.5% in Group I versus 7.4% in Group II, P < .005) and mortality (1.76% versus 0.30%, P < .005) were higher in Group I. During late follow-up, the 2-year survival rate (85.1% versus 94.5%) and 2-year event-free rate (77.6% versus 86.9%) were significantly lower in Group I when compared to Group II. Postoperative left ventricular ejection fraction values were significantly superior in Group I compared to Group II.
  
  
  CONCLUSIONS
  Coronary artery bypass grafting can be safely performed in patients with low ejection fraction with minimal postoperative morbidity and mortality. The viable myocardium could be reliably determined by positron emission tomography. Low ejection fraction patients could greatly benefit from coronary bypass surgery regarding postoperative ejection fraction, increased long-term survival, improvement in New York Heart Association classification, and higher quality of life.
authors.affiliation: Cardiovascular Surgery Department, Sifa University, Izmir, Turkey. ihsansami@hotmail.com
authors.forename: Ihsan Sami
authors.initials: IS
authors.lastname: Uyar
authors.forename: Veysel
authors.initials: V
authors.lastname: Sahin
authors.forename: Mehmet Besir
authors.initials: MB
authors.lastname: Akpinar
authors.forename: Feyzi
authors.initials: F
authors.lastname: Abacilar
authors.forename: Volkan
authors.initials: V
authors.lastname: Yurtman
authors.forename: Faik Fevzi
authors.initials: FF
authors.lastname: Okur
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ates
authors.forename: Talat
authors.initials: T
authors.lastname: Tavli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D003657:Decision Making; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*